Enter your email to subscribe:

The Washington Post reported today on the Iqbal case alleging that former attorney general John Ash croft and FBI Director Robert Mueller knew that the prison guards holding Arab Muslims swept up after the September 11 attacks were torturing them because they were Arabs and/or Muslims.

The Supreme Court ruled today that former attorney general John
Ashcroft and FBI Director Robert Mueller may not be sued by Arab
Muslims who were seized in this country after the 2001 terrorist attacks and allege harsh treatment because of their religion and
ethnicity. The court ruled 5 to 4 that the top officials are not liable for the
actions of their subordinates absent evidence that they ordered the
allegedly discriminatory activity. The decision followed the court's
ideological split between conservatives and liberals, with Justice
Anthony M. Kennedy siding with the conservatives and writing the
opinion.

The suit against Ashcroft and Mueller was brought by a Pakistani
citizen living legally in the country when he was arrested in the
months after the Sept. 11, 2001, terrorist attacks on the World Trade
Center and Pentagon. Javaid Iqbal was held in solitary confinement in a section of a
Brooklyn prison known as Admax-Shu, for "administrative maximum special
housing unit," where he said he was subjected to numerous beatings and
strip searches. He was convicted of document fraud and deported to
Pakistan but cleared of any involvement in terrorism. An Egyptian
Muslim who was also part of the suit, Ehad Elmaghraby, settled with the
government for $300,000. Similar suits are pending.

Iqbal's case names prison guards, FBI agents, the warden of the
prison -- who was the subject of a critical report from the Justice
Department inspector general -- up to Ashcroft, who was attorney
general at the time of the attack. Iqbal says policies formulated by
Ashcroft and Mueller singled him out as a suspect of "high interest"
solely because of his nationality and religion.

The U.S. Court of Appeals of the 2nd Circuit in New York
acknowledged that top government officials carry immunity but decided
it was at least "plausible" that Ashcroft and Mueller were responsible
for, or knew about, the discriminatory actions Iqbal alleges. It said the suit could go forward with evidence-gathering from the
lower-level officials in the case, and then a judge could decide
whether there was reason to keep the two top officials in the suit.

But Kennedy said that decision was wrong, and Iqbal had no plausible
claims that Ashcroft and Mueller knew of or put in place a
discriminatory policy. His claims "amount to nothing more than a formulaic recitation of
the elements of a constitutional discrimination claim," Kennedy wrote. Kennedy said it was logical that the largest law enforcement
investigation in the nation's history focused on Arab Muslims because
of the identities of the Sept. 11 attackers. "It should come as no surprise that a legitimate policy directing
law enforcement to arrest and detain individuals because of their
suspected link to the attacks would produce a disparate, incidental
impact on Arab Muslims, even though the purpose of the policy was to
target neither Arabs nor Muslims," he wrote.Similarly, it was not discriminatory that Iqbal and others were
detained in a maximum security prison, Kennedy said. "All it plausibly
suggests is that the nation's top law enforcement officers, in the
aftermath of a devastating terrorist attack, sought to keep suspected
terrorists in the most secure conditions available until the suspects
could be cleared of terrorist activity."

Justice David H. Souter wrote for the dissenters. He said the
conservative majority went further to insulate public officials from
civil liability than Ashcroft and Mueller had even asked for. "The court denied Iqbal a fair chance to be heard," Souter wrote.

This case may not seem important from an environmental standpoint. But I think it is. The United States has long been the biggest polluter in the United States. We primarily depend on internal discipline and the prospect of federal criminal prosecution to prevent federal officials from feeling wholly immune from state and federal environmental laws. These remedies rely on the diligence of the federal government in self-policing itself and its officers to assure that the federal government does not injury citizens through pollution. Citizen suits, judicial review actions, and state enforcement actions are directed at the government, but do not provide federal officers with personal exposure to penalties. Federal officers also enjoy immunity from ordinary state tort actions, with the U.S. being substituted for the individual officer in such cases. Thus, Bivens actions can be the remedy of last resort where federal officers endanger individual citizens through their misconduct.

The Iqbal decision prevents the use of supervisory liability ala Dotterweich and Park in the Bivens tort context. Even if the supervisor is standing by and watching the misconduct of subordinates, the supervisor is not liable for the acts of those subordinates. This is an extremely dangerous incursion on federal supervisors being held responsible for the conduct they condone by their subordinates -- when federal supervisors, knowing that their subordinates are systematically violate the constitutional rights of others, stand silence, they condone and tacitly consent to that conduct. Iqbal is bad law and bad policy.

The
economic recovery packages put forward by many countries spend lots of money, but a key question is whether the packages will have a beneficial impact on greening
the global economy. Although few contain adequate
detail for full assessment, some are likely beneficial and some are actually counterproductive in moving the world toward a low carbon economy.

A study commissioned byE3G and WWF and prepared by Germanwatch and Ecofys on the climate friendliness of recovery packages provides
a detailed and comprehensive analysis of the proposed
’stimulus’ packages of five key countries - France, Germany, Italy,
the UK and the US - as well as examining the package agreed by the European
Union as a whole.

The
economic/climate recovery score cards created as part of the study are available on the following websites:

Corruption and poor governance are generally recognized as a key obstacle to achieving the Millennium Development Goals, ecological sustainability, social equity, and economic development as well as realizing human rights in many developing countries. The problem has been that the weapons that the United States and other governments have used against corrupt leaders who plunder their countries' resources and violate their citizens' human rights were relatively blunt: military invasion, assassination, promotion of coup d'etat, suspension of trade and aid, etc. But yesterday a French judge opened a judicial investigation about corruption of three African leaders. So another, more nuanced weapon has been added to our collective arsenal.

Meanwhile, the Europeans aren't just taking African leaders to task. Spain is also investigating lawyers and others from the Bush administration regarding their roles in approving torture tactics against alleged terrorist suspects. Certainly we all know that the leaders of developing countries have no monopoly on corruption or human rights violations!

A
French NGO has caught an investigator's attention with its complaint
about excessive spending by 3 African leaders -- all 3 of whom, it
should be noted, hail from countries whose people are said to suffer
from human rights violations.

Proceedings could extend to many posh holdings; specifically, in the case of:► Teodoro Obiang Nguema,
Equatorial Guinea's President since 1979, and family: At least 1
property, 1 bank account, and more than 4 million euros worth of luxury
vehicles. Among them is the Rolls-Royce Phantom limousine depicted
above, said to have been bought by Obiang's son. (photo credit) Obiang has been dubbed among the few "African despots who make Robert Mugabe seem stable and benign" by The Independent of London.

► Omar Bongo,
President of Gabon since 1967, and family: 39 properties, 70 bank
accounts, and nearly 1.5 million euros worth of luxury vehicles. In
January Bongo, the world's longest-serving ruler, was publicly criticized by members of the U.S. Congress for having arrested and otherwise harassed members of civil society who campaign against public corruption.► Denis Sassou-Nguesso,
since 1979 the President of the Republic of Congo (commonly called
Congo-Brazzaville to distinguish it from the neighboring state whose
capital is Kinshasa, the Democratic Republic of Congo): 24 properties,
112 bank accounts, and more than 172,000 euros worth of luxury
vehicles. In Sassou-Nguesso's country, slavery of 1 ethnic group by another is reported to persist.

Despite the risk of upset on appeal, the attorney representing the parties civiles, William Bourdon, lauded Desset's initiative:

'This
is a decision without precedent, because it is the first time that a
judicial investigation has been opened concerning the alleged
misappropriation of public funds by incumbent heads of state. From now
on it is possible to identify and pursue those who, repeatedly and
deceitfully, impoverish their own countries.'

It also suggests a Capone-precedent path to pursuit of leaders who fail to protect the human rights of their own people.

As this report on the new studies published in Nature indicates, the global warming problem is and always has been understood to be a matter of the total loadings of GHG emissions in the atmosphere, not a matter of timing. The timing of the GHG emissions only matters over the course of centuries because eventually greenhouse gases emitted into the atmosphere decompose. I don't think that anyone familiar with climate policy has ever believed otherwise. So, on that score the new studies are not new, but they may alter how the problem is conceptualized for policy purposes.

Policy cannot simply divide the total allowable emissions among nations and be done with it. First, absent intermediate goals tied to deadlines, countries cannot monitor each others compliance with reduction targets. Second, it creates a tendency for nations to believe that they can just wait until 2050 or whatever when technology will save them and voila they will become carbon neutral. Our experience in the Clean Air Act attainment with NAAQS was that, faced with a deadline and no requirement for annual progress, states just planned to do something at the last moment and when their plans didn't work, they threw up their hands and said, "OH well."

We cannot afford to use that model of regulation with respect to climate. Instead, we need to use technology-forcing technology based standards (e.g. no new coal plants without CSS; CSS retrofit for existing fossil-fuel plants by 2020) along with streamlining the ability of renewables to come online and planning ala the 1990 Clean Air Act amendments with annual progress requirements and contingency measures built into the plan. Those approaches would be far more successful than the "consume up to the last moment" strategy that may be encouraged by the total emissions approach.

Lawyers have to leave science to the scientists and use extreme care when they are working on a cross-disciplinary basis. But scientists need to be just as wary of providing policy concepts unencumbered by an understanding of past performance of various regulatory approaches.

Scientists hope a new approach to assessing carbon build-up in the atmosphere willsimplify issues for policymakers and economists. Two papers published in Nature today (29 April) show that the timings of carbon emissions are not relevant to the debate — it is the total amount of carbon dioxide emitted over hundreds of yearsthat is the key issue.

Rather than basing negotiations on short-term goals such as emission rates by a given year, the researchers say the atmosphere can be regarded as a tank of finitesize which we must not overfill if we want to avoid a dangerous temperature rise.

Climate policy has traditionally concentrated on cutting emission rates by a givenyear, such as 2020 or 2050, without placing these goals within the overall contextof needing to limit cumulative emissions.

Both papers analyse how the world can keep the rise in average surface temperaturesdown to no more than two degrees Celsius above pre-industrial levels. This figure iswidely regarded as the threshold beyond which the risk of dangerous climate changerapidly increases. Policymakers around the world have adopted this limit as a goal.

The first study, led by Myles Allen from the University of Oxford, UK, found thatreleasing a total of one trillion tonnes of carbon dioxide into the atmospherebetween 1750 and 2500 would cause a "most likely" peak warming of two degreesCelsius. Emissions to 2008 have already released half of this. Allen said in a press briefing this week (27 April): "It took 250 years to burn thefirst half trillion tonnes and, on current predictions, we'll burn the next halftrillion in less than 40 years."

The second study, led by Malte Meinshausen at the Potsdam Institute for ClimateImpacts Research, Germany, used a computer model to demonstrate that to avoidexceeding two degrees Celsius by 2100, cumulative carbon emissions must not exceed0.9 trillion tonnes. "We have already emitted a third of a trillion in just the past nine years,"Meinshausen says.

David Frame, a co-author of the Allen paper and researcher at the University ofOxford, said that these findings make the problem "simpler" than it's oftenportrayed. "[The findings] treat these emissions ... as an exhaustible resource. Foreconomists, this way of looking at the problem will be a huge simplification," Framesaid. "Basically, if you burn a tonne of carbon today, then you can't burn it tomorrow" you've got a finite stock. It's like a tank that's emptying far too fastfor comfort. If country A burns it, country B can't. It forces everyone to considerthe problem as a whole."

In a separate essay, Stephen Schneider of the Woods Institute for the Environment atStanford University in the United States, discusses what a world with 1,000 partsper million of carbon dioxide in its atmosphere might look like.

This article is reproduced with kind permission of theScience and Development Network (SciDev.Net).For more news and articles, visit www.scidev.net.

Abstract

Global efforts to mitigate climate change are guided by projections of future temperatures1.
But the eventual equilibrium global mean temperature associated with a
given stabilization level of atmospheric greenhouse gas concentrations
remains uncertain1, 2, 3, complicating the setting of stabilization targets to avoid potentially dangerous levels of global warming4, 5, 6, 7, 8.
Similar problems apply to the carbon cycle: observations currently
provide only a weak constraint on the response to future emissions9, 10, 11.
Here we use ensemble simulations of simple climate-carbon-cycle models
constrained by observations and projections from more comprehensive
models to simulate the temperature response to a broad range of carbon
dioxide emission pathways. We find that the peak warming caused by a
given cumulative carbon dioxide emission is better constrained than the
warming response to a stabilization scenario. Furthermore, the
relationship between cumulative emissions and peak warming is
remarkably insensitive to the emission pathway (timing of emissions or
peak emission rate). Hence policy targets based on limiting cumulative
emissions of carbon dioxide are likely to be more robust to scientific
uncertainty than emission-rate or concentration targets. Total
anthropogenic emissions of one trillion tonnes of carbon (3.67 trillion
tonnes of CO2), about half of which has already been emitted
since industrialization began, results in a most likely peak
carbon-dioxide-induced warming of 2 °C above pre-industrial
temperatures, with a 5–95% confidence interval of 1.3–3.9 °C.

Department of Physics, University of Oxford, OX1 3PU, UK

Smith School of Enterprise and the Environment, University of Oxford, OX1 2BQ, UK

JURIST Guest Columnist Ed Richards
of Louisiana State University Law Center says that in the midst of
current concerns about the spread of the H1N1 virus (popularly known as
"swine flu"), passing more and stricter public health laws will neither
strengthen the public health system nor effectively contain the spread
of disease...

As
this is being written, H1N1 is not a major threat, but this could
change as the epidemic evolves. I want to look past the H1N1 outbreak
and focus attention on what we will carry away from it, however it
evolves. I am concerned because crisis-driven policy is easy to hijack,
resulting in laws with horrible unintended consequences. Over the past
four decades, public health crises have generated more than their share
of bad laws. Some only create false expectations, but others have lead
to great suffering and even death. I hope forewarned is forearmed for
H1N1.

Do We Need More Law?

It is not law per se
that I worry about. I am quite supportive of public health law as
expressed through administrative regulations and the broad exercise of
the police powers. While public health depends primarily on voluntary
cooperation, state public health agencies and the federal government
have tremendous powers
to deal with a public health crisis. The United States entered the
1970s with a public health system that had nearly tripled life
expectancy over the past 100 years through sanitation, which had nearly
wiped out the worst of the communicable diseases in the U.S., and which
was immunizing a sizable part of the population against seasonal flu.
All this, including the quarantine of individuals and whole regions,
had been managed through general grants of legislative power and
administrative regulations. This framework has not been declared
unconstitutional and as classic administrative law, there is no reason
to think the United States Supreme Court would stop deferring to agency
action in public health when it supports agency deference in all other
areas of administrative law.

The Interest Groups

What
I worry about are statutes, i.e., specific public health policies
passed into statutes to please interest groups. From quarantining
people who are coughing to taxing fat people, pushing for public health
statutes has become the rage at the CDC, federal and state
legislatures, and private foundations. These are driven by traditional
interest groups, such as employers worried about health care costs,
drug companies, military contractors who want to sell bioterrorism
monitors, and federal officials in recent administrations who wanted to
extend the national security state.

The last decade has seen a
new interest group arise: contract researchers operating out of
universities who live on grant funds to write new laws. No matter the
problem, their solution is a new law, because they make no money if
they admit that the problem is just that public health agencies do not
have the staff to do a job because they are broke, or that there is no
problem at all. Expect to see these groups calling for massive new
public health powers to deal with H1N1, claiming that public health
agencies and the federal government lack key powers. As noted below,
public health emergencies are fully integrated into our national
security laws, allowing the federal government essentially unlimited
powers if it chooses to use them. Perhaps the only real limit is that
since President Obama repudiated the torture memos, the torture of potential disease carriers is now off limits.

Untended Consequences - The Road to Hell

Concerns
with the public health consequences of illegal drug use in the 1960s
led to Nixon's war on drugs and Rockefeller's draconian drug laws,
which spread across the United States. These laws have had profound
unintended consequences and seem to slip the mind of public health law
scholars who tout the value of new public health statutes. In the
1980s, civil libertarians lobbied state legislatures and Congress to
protect persons with AIDS. The result was to make it nearly impossible
to do public health screening and case finding for HIV infection. This
exacerbated the AIDS epidemic and was only reversed as a matter of
federal policy in 2006.
Many states still have laws in place that limit disease control efforts
for HIV. (In several states, the entire disease control code was
revised, undermining the control of tuberculosis and other diseases.
These laws had to be revised again as tuberculosis surged in the 1990s.)

Post 9/11 and the anthrax letters, fears of bioterrorism lead the CDC to develop the Model State Emergency Health Powers Act
and push states to adopt it. This was criticized by many public law
scholars for being a dangerous intrusion into civil liberties and
probably also unworkable. More fundamentally, if you are versed in
national security law, you know that the push for public health
emergency powers laws at the state and federal level were derived from
the Bush/Cheney vision of the seamless national security state. Taken
with the Patriot Act and other national security laws, public health
and safety emergencies have been recharacterized as national security
threats, which creates paths for the use of the military in domestic
policing and the overruling of state public health authority by the
federal government.

The real problem with all of these laws is
that the problems they address are not problems of legal authority.
They do nothing to address the loss of resources and expertise from
health departments, and the weakness of political leaders when facing
difficult choices. We have created a system of Potemkin laws whose real
purpose is to allow legislatures to claim to have done something about
public health emergencies without spending the money or political
capital to address the weakness in the public health and medical care
system. Look how well these laws worked for Hurricane Katrina.
Louisiana had passed stacks of emergency powers laws after 9/11, had
done all the federal planning exercises, yet was completely unprepared
for Hurricane Katrina because that would have required spending money
and admitting that New Orleans could flood. Yet Katrina spawned another
deluge of federal and state emergency powers laws, passed as states
continued to cut their already inadequate health department budgets.

What We Did Not Learn From SARS

The most recent failure, and the one most on point with H1N1, was the reaction to the 2003 SARS
outbreak. Canada appointed a royal commission to study and make
recommendations about the lessons learned from SARS. The commission
published an excellent set of reports
on all aspects of the SARS epidemic and the government's response. The
commission was clear: strategies such as social distancing, not going
to work sick, and voluntary isolation can work only if the affected
individuals are supported by the employers and the government.
Individuals must have paid sick leave, worker's compensation must cover
workplace acquired infection, there must be health insurance coverage
for personally acquired illness, and employers and others institutions
must workout the details of mandatory immunization programs with unions
and workers before there is an outbreak.

The Canadians found
little or no role for coercion, but a critical role for the government
and employers to provide support to allow individuals to stay home
without loss of income and with adequate medical care and food. The
response in the United States was to pass even more quarantine laws, to
provide bench books to judges on how to enforce those laws, and to
encourage local law enforcement to think about their rules of
engagement when enforcing quarantine - do you shoot the soccer mom
fleeing with the minivan full of children?

There have been no
provisions for the nearly half of workers without paid sick leave, for
workers with infected family members who will lose pay if they stay
home, for health care for the uninsured. The huge population of
undocumented aliens and the legal and illegal underground economy have
been ignored, yet we know those who participate in the underground
economy are not likely to honor snow days and other social distancing
strategies because they do not eat if they do not work.

What Will We Not Learn From H1N1?

The
best outcome for H1N1 is that we have relatively few cases and deaths,
we will develop a vaccine over the summer, we will conduct an orderly
vaccination program in the fall, and H1N1 will become just one virus on
the list we consider for each seasonal flu vaccine. (For perspective,
remember that yearly flu outbreak results in a few million cases and
10-20,000 deaths, with no great disruption in life and the economy.) We
will look back and realize that it would have been nice to have more
epidemiologists in the states with cases, and the states and the
federal government will increase funding and job protections for expert
staff at health departments.

More likely, whatever the outcome
of H1N1, the result will be more laws benefiting more interest groups
and politicians' reelection campaigns, and no long-term support for the
public health system.

Edward P. Richards III
is Harvey A. Peltier Professor of Law at the Louisiana State University
and Director of the Program in Law, Science, and Public Health.

I find a good deal to agree with in Prof. Richards' column, but I fear that he paints with too broad a brush.

Prof.
Richards is of course correct that crises, and associated panic (of the
sort promoted by the nonstop cable news outlets competing for viewers,
properly lambasted on the Daily Show), tend to result in ill-considered
emergency legislation (think PATRIOT Act in another context), often
with unforeseen negative consequences (or carefully plotted ones for
which the emergency provides a pretext: think PATRIOT Act). Often
proper enforcement of pre-existing laws and regulations, coupled with
adequate resources, would be far more effective in preventing or
mitigating crises than emergency legislation will do in reacting to
them (think banking and securities laws and regulations in our current
financial meltdown).Finally,sensitive facilitation of desirable
private actions can constitute far sounder public policy than punitive
and coercive measures, as Prof. Richards' comparison of Canadian and
American responses nicely illustrates. So far, so good.

But I am
not so convinced by other aspects of Professor Richards' catalog. Did
our punitive and self-defeating war on drugs really result from, and
remain in place because of, classical public health concerns--or does
this reflect certain puritanical tendencies deep in American culture
(think Prohibition) and the interests of the law
enforcement-prison-industrial state? For many years, public health
authorities have promoted a harm minimization strategy that has thus
far had minimal impact on deconstructing the war on drugs (even
recreational drugs posing relatively minor risks to public
health)--although perhaps a moment of at least minor reform may be
approaching. To be sure, the picture is not entirely uniform; the
hysteria in the early days of crack cocaine, and the rush to impose
severe penalties disproportinate to penalties on powder, did result in
part from public health concerns, and did result in starkly different
law enforcement responses on users in minority communities than for the
economic elites able to afford their drugs of choice.

The AIDS
example is also more complex, involving challenging conflicting
approaches and priorities between medical confidentiality and
protection of civil rights for those known to be afflicted. From this
distance, one can reasonably argue that we did not get the balance
right in real time, and that a different balance might have don e a
better job of reconciling civil rights with disease prevention. But the
fact that laws were eventually modified is not in itself conclusive; as
scientific knowledge improved, hysteria diminished, civil rights
protections were solidified (at least in some respects), the disease
became more treatable, and HIV-infected individuals became less
isolated and stigmatized, circumstances changed and the appropriate
legal adjustments could follow--not least because the problems sought
to be addressed had changed.

This highlights what I hope may be
another area of potential agreement. Crises makes it easier to rush
legislative changes through--including those that are ill-considered.
It is often--certainly sometimes-- the case that thoughtful and
well-considered legislative or regulatory approaches have been prepared
in calmer times, but cannot achieve the political support or momentum
necessary for enactment in the absence of a crisis. Not all law is bad,
although we can probably identify some of the circumstances conducive
to better, or less well considered, legislative or regulatory
proposals. We need to do better in that dimension, although I am not
convinced we have figured out just how to accomplish that.

We
have become in increasingly aware of the global nature of many emerging
health threats, and of marked disparities in the capacities of
different societies to respond in open, timely, and appropriately
resourced fashion. For all the difficulties in the American system of
federalism and divided control over health matters, the problems at the
international level are far more formidable. Whether law is the best
instrument here is yet to be determined. Perhaps Professor Richards
will address that aspect of the issue in a future posting; I look
forward to hearing his thoughts.

Alan Jay WeisbardAssociate
Professor (retired) of Law and of Medical History and Bioethics,
University of Wisconsin Schools of Law and of Medicine and Public
Health, and former Executive Director, NJ Bioethics Commission

H1N1 influenza 4 p.m. update__________________________________________________________________________Cases: As of late Saturday, Oregon had identified eleven probable cases ofH1N1 influenza virus with additional specimens being tested at the Oregon StatePublic Health Laboratory in Hillsboro. State public health officials expect to knowin the next few days whether any of the cases are confirmed as H1N1.The county breakdown of the eleven probable cases is listed below:• Lane (2)• Marion (1)• Multnomah (2)• Polk (2)• Umatilla (1)• Wallowa (1)• Washington (2)“None of these 11 individuals has been hospitalized,” Mel Kohn, M.D., statepublic health officer in the Oregon Department of Human Services, said today.“However, the fact that this is a new strain of flu means we still need to beconcerned and be preparing for what may come.”

CDC continues to take aggressive action to respond to an expanding outbreak caused by novel H1N1 flu.

CDC’s response goals are to:

Reduce transmission and illness severity, and

Provide
information to help health care providers, public health officials and
the public address the challenges posed by this emergency.

CDC continues to issue and update interim guidance
daily in response to the rapidly evolving situation. CDC will issue
updated interim guidance for clinicians on how to identify and care for
people who are sick with novel H1N1 flu illness. This guidance will
provide priorities for testing and treatment for novel H1N1 flu
infection. The priority use for influenza antiviral drugs during this
outbreak will be to treat people with severe flu illness.

On
May 3, CDC is scheduled to complete deployment of 25 percent of the
supplies in the Strategic National Stockpile (SNS) to all states in the
continental United States. These supplies and medicines will help
states and U.S. territories respond to the outbreak. In addition, the
Federal Government and manufacturers have begun the process of
developing a vaccine against the novel H1N1 flu virus.

Response
actions are aggressive, but they may vary across states and communities
depending on local circumstances. Communities, businesses, places of
worship, schools and individuals can all take action to slow the spread
of this outbreak. People who are sick are urged to stay home from work
or school and to avoid contact with others, except to seek medical
care. This action can avoid spreading illness furth

Outbreak in Mexico May Be Smaller Than Feared

The swine flu outbreak in Mexico may be considerably smaller than originally feared, test results released there on Friday indicate.

Of 908 suspected cases that were tested, only 397 people turned out to have the virus, officially known as influenza A(H1N1), Mexican health officials reported at a news conference. Of those, 16 people have died.

Mexico had reported about 2,500 suspected cases as of Friday, but
the number of real cases could turn out to be less than half the
suspected number if further testing follows the same pattern as the
original round. Officials said that the tests were being done quickly,
and that 500 more would be completed Friday.

José Ángel Córdova, Mexico’s health minister, said, “This is a new
epidemic, and we can’t predict exactly” what it will do. “We need more
days to see how it behaves,” he said.

“Apparently the rate of infection is not as widespread as we might
have thought,” he added. The materials needed for the test were
provided to Mexico by the United States Centers for Disease Control and Prevention.

Officials at the centers declined to say what the new numbers might mean.

“We are continuously assessing new information, but it is still too
early to draw conclusions about the extent of the spread of this new
virus in Mexico or the severity of disease caused by it,” Dr. Nancy
Cox, chief of the influenza section, said by e-mail, when asked to
comment on the test results.

Dr. Javier Torres, the head of the infectious disease research unit at the Mexican Social Security Institute, Mexico’s main public health care system, said that he had been analyzing the past week’s influenza statistics.

“The number of those exposed and infected has gone up, and the
number of fatal cases has gone down,” he said. “We can be comfortable
with those facts.”

Officials at the World Health Organization,
which has declared that a pandemic is imminent, declined to comment
beyond saying that the investigation into the outbreak was continuing.

But a public health and infectious disease expert from Vanderbilt University,
Dr. William Schaffner, said the test results were “going to change, I
think in a substantial way, the image of this outbreak in Mexico.”

If the outbreak is much smaller than initially thought, Dr.
Schaffner said, “It would, I think, enable the world’s public health
community to take a deep breath and continue to track the outbreak and
reduce the tendency, as the W.H.O. has been doing, to notch up on its
pandemic scale.”

If the testing also shows that the disease has caused fewer deaths
than the 170 or so suspected, Dr. Schaffner said, it might resolve a
question that has been puzzling health experts since the outbreak
began: why did the disease appear to be so much more severe in Mexico
than in the United States? In the United States, cases have been mild
and there has been only one death, that of a 23-month-old child from
Mexico. Meanwhile, the disease continued to spread to other countries
and was confirmed in more American states on Friday. The disease is
expected to drop off during the summer, because flu
viruses do not thrive in heat and humidity, but it could rebound in the
fall and winter. The World Health Organization said that the flu
vaccine given to millions of people for the most recent flu season
appeared ineffective against the A(H1N1) strain, but that health
officials were talking to manufacturers about creating a new swine-flu vaccine, which would take four to six months to produce.

Dr. Marie-Paule Kieny, director of the Initiative for Vaccine
Research at the World Health Organization, said that unless the numbers
of cases decreased significantly, “it seems mostly likely that the
manufacturers will proceed and we will certainly support them.”

Officials at the Centers for Disease Control said a decision had not yet been made about whether to manufacture a vaccine, but President Obama said that the government would support it.

New cases were reported in Denmark, France, Russia, Hong Kong and
South Korea on Friday, but they were not confirmed by the health
organization. The United States reported 141 confirmed cases in 19
states, up from 109 cases in 11 states on Thursday.

Concerns about the disease are having an increasing impact. On Friday, a United Airlines
flight with 245 passengers heading from Munich to Dulles Airport in
Washington landed in Boston instead because a female passenger had flu
symptoms and the airline thought she needed prompt attention, a United
Airlines spokesman said.

In New York, the school with the nation’s largest cluster of swine
flu to date — St. Francis Preparatory School in Fresh Meadows, Queens —
was set to reopen Monday after being closed for a week.

Researchers say that some genetic features of the virus may help explain why many cases tend to be mild.

“We do not see the markers for virulence that were seen in the 1918
virus,” said Dr. Cox, of the Centers for Disease Control. “However, we
know there is a great deal we don’t understand about the virulence of
1918 or other viruses that have a more severe clinical picture in
humans.”

It is too early to know what economic impact, if any, the flu outbreak might have on the United States economy. The Congressional Budget Office
estimates that the recession will push this year’s national economic
output 7.5 percent below its potential level. A true flu pandemic could
shave off an additional 1 to 4.25 percent and could have a similar
effect on the world’s output, too, some economists say.

Denise Grady and Liz Robbins
reported from New York. Reporting was contributed by Larry Rohter and
Elisabeth Malkin from Mexico City, Keith Bradsher from Hong Kong, and
Anemona Hartocollis and Catherine Rampell from New York.

• Sustained human-to-human transmission has remained only in Mexico and USA, thereforephase 5 continues to be in effect.

• The World Health Assembly (WHA) is scheduled in Geneva as planned (18-27 May 2009).

• As of today, WHO has decided to refer to the virus as Influenza A/H1N1.

Status of the Region

• Mexico: 397 confirmed cases, including 16 deaths. There has been an increase in totalconfirmed cases in Mexico mostly due to testing of backlogged cases. At the same time, thenumber of probable cases appears to be decreasing in the Mexico City area.

• The United States: 160 confirmed cases, including 1 death.

• Canada: 70 confirmed cases; some with recent travel history to Mexico.

• Costa Rica: 1 confirmed case with recent travel history to Mexico.

• A daily epidemiological report is posted on the PAHO website1; updated epidemiologicalreports from Mexico can be found on the Dirección General de Epidemiología2.

*Deaths: 168 deaths in Mexico, 12 confirmed as swine flu. One confirmed in U.S., a nearly 2-year-old boy from Mexico who died in Texas.

**Confirmed sickened worldwide: 504; 300 confirmed
as having swine flu in Mexico; 133 in U.S.; 35 in Canada; 13 in Spain;
eight in Britain; four each in Germany and New Zealand; two in Israel;
one each in Switzerland, Austria, China, Denmark and the Netherlands.
Mexico is no longer releasing "suspected" numbers; the number of
suspected cases was 2,498 before the tally was halted.

**U.S. confirmed sickened, by state: 50 in New
York; 26 in Texas; 18 in California; 10 in South Carolina; five in New
Jersey; four each in Arizona and Delaware; two each in Kansas,
Colorado, Virginia, Michigan and Massachusetts; and one each in
Indiana, Ohio, Georgia, Minnesota, Nebraska and Nevada.